Mainstreaming a health systems’ approach to
maternal health programming: trans-disciplinary
research in Rwanda and South Africa
Maternal Health in South Africa and Rwanda (MHSAR) Project
Overview
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July 2012 - June 2016
South Africa and Rwanda
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Centre for Health Policy (CHP), Wits University
School of Public Health, UWC
Nijmegen International Center for Health Systems
Research and Education (NICHE), Radboud University
Ministry of Health, Rwanda
Gauteng and Eastern Cape DoH, South Africa
Aim to investigate the linkages between key
health system components and maternal health
Subproject 1a
• Systematic review of the
impact of health system
supply & demand
interventions on MH
health in LMICs
Subproject 1b
MHSAR
sub-projects
• Realist review impact of
health system supply &
demand interventions on
MH in selected LMICs
Subproject 2a
• Case studies in Rwanda and
South Africa using EmOC
and HIV as health system
probes to investigate
linkages between health
system components & MH
Subproject 2b
• Action research health
system interventions to
improve organisation and
delivery of MH services
Policy Relevant Questions
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What has been the impact of health system
interventions (health system strengthening) on
maternal health?
What are the most important health system
factors influencing the performance of maternal
health programmes?
What health system interventions should be
implemented to improve maternal health in
South Africa and Rwanda?
Progress
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1a. Systematic review: Completed
1b. Realist review: Ongoing
2a. Case studies
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Eastern Cape: Completed
Gauteng: Ongoing
Rwanda: Ongoing
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2b. Action research: Initiating
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2 PhDs: Ongoing
1 Post-Doc: Completed
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Main Stakeholders
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Health system + MH policymakers & managers
(national, provincial, district)
Health professional organisations
International agencies
NGOs & advocacy groups
Health system + MH researchers
Stakeholder Engagement Strategies
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Inception workshop
Active partnerships with DoH/MoH
Joint planning meetings
Participation in annual project meetings
Feedback workshops
KT Products
To Date
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Feedback workshops
Media briefing
WHO guidelines
Academic papers
Academic conferences
Planned
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Case study policy
engagement workshops
Policy briefs
Academic papers
Academic conferences
Video?
Preliminary Key Messages
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Inadequate attention to HSS in  Systematic review
filler text
maternal health
er text
Focus mostly on HR &
financing building blocks
Key HS resource gaps
 Comparative case
undermine performance
studies filler text
filler text filler text
Importance of governance &
filler text filler
accountability in explaining
variation in MH performance
text
But require packages of HS
interventions addressing
multiple building blocks
KT Opportunities & Challenges
Opportunities
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Direct involvement of
MoH/DoH
Policy engagement in
sub-project 2b
Existence of MH policy
groups
Involvement in WHO
guidelines
Challenges
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Balancing partnership
and criticism
Engaging with other
stakeholders (women,
media)
Multiple health system
levels
Limited KT human &
financial resources
KT Support Needed
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Financial support for Eastern Cape policy
engagement workshops (2nd KTNet Call)
Collaboration in Rwanda case study
dissemination (Sharenet small grant)
Expertise for video documentary
Advise on engagement with media, pregnant
women